RANDOLPH KEN SHOUP Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****97

License Status

NOT RENEWED

Business

First Name

RANDOLPH KEN

Last Name

SHOUP

Business Name

RANDOLPH KEN SHOUP

Original Issue Date

09/15/1981

Effective Date

09/15/1981

Expiration Date

09/30/1984

City

CAIRO

State

Zip

62914

County

ALEXANDER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005